Voices of Eating Disorders

The New York Times is running a "Patient Voices: Eating Disorders" feature today, which includes interviews with female and male sufferers at different points of recovery. A mother of one of the sufferers is also interviewed.

Patrick Bergstrom talks about the connection between perfectionism and eating disorders, and how he struggled to recover in a treatment center that catered mostly to women. Emily Hertz, a recovering anorexic, remembers a comment her grandfather made to her when she was just nine years old: "If you keep eating those Skittles, you're going to get fat." Kirsten Haglund, Miss America 2008, reflects on how her eating disorder isolated her from the people she cared about. Disappointingly, there is not much ethnic diversity here, which doesn't do much to dispel the myth that eating disorders are a white issue. That said, the piece is definitely worth checking out.

Pregorexia: What Happens When Moms-to-Be Aren't Eating Enough?

We have written before about the insane amount of pressure pregnant women and new moms face in our "get your pre-baby body back" culture. We've also talked about the fact that we now need a new dictionary to define all the terms that are popping up to describe disordered eating behavior, a surefire sign that our collective attitudes about food and weight have gone off the deep end. Now we've officially arrived at the intersection of these two observations: Pregorexia.

"Pregorexia" is another media-coined term used to refer to mothers who are so terrified of gaining weight during their pregnancies that they diet and put their own health and the babies health at risk. Those health risks include anemia, low birth weight, heart palpitations, and rickets. Of course, women are warned not to gain too much weight either, because that comes with a whole other set of health risks. No pressure or anything. Just get it perfect, okay?

We're hearing a lot of accusations of women putting vanity before the health of their babies. We'd like to slow down the judgment train for a second. It's a pretty widely accepted fact that many women have serious body image issues, weight concerns (and yes, eating disorders) before they get pregnant, right? So why are we all so quick to assume that those issues will magically melt away as soon as women decide to become moms? What resources are available to help us cope with the body changes and body pressures that come with pregnancy and motherhood? The fact is that we're surrounded by "Celebrity Moms' Diet Tricks!" magazine covers (sometimes in the OB/GYN's office, thanks very much), but the voices of reason are few and far between.

Our recommendations? Women need doctors who are sensitive to and knowledgeable about body image issues, and we need to talk honestly with each other about how we're coping with these pressures instead of quizzing each other on how much weight we've gained or lost during and after pregnancy. What do you think? [Daily Mail] via [Shine]

Eating Disorders and The Olympics: Is the IOC Doing Enough?

It's almost time to let the games begin, but as controversy swirls around the hot topics of performance-enhancing drug use and gender testing at the Olympics, another major issue gets less attention from the officials: eating disorders.

According to a study published last year in the Psychology of Sport and Exercise journal, almost one in five of Britain's leading female distance runners has an eating disorder or has suffered in the past. We would venture to guess that the U.S. numbers match up pretty closely. Does anyone remember Dying to Be Perfect: The Ellen Hart Pena Story (Yep, Lifetime movie)? And it's not just runners, of course. Little Girls in Pretty Boxes highlighted the struggles of figure skaters and gymnasts (Uh, yeah, Lifetime again. Although to be fair, it was a book first). Gymnast Jennifer Sey just chronicled her own experience with eating disorders and depression in Chalked Up: Inside Elite Gymnastics' Merciless Coaching, Overzealous Parents, and Elusive Olympic Dreams and American swimmer Dara Torres just inked a deal (sub required) to write her memoir, which includes a discussion of her battle with bulimia.

We talk about how the world of modeling is a breeding ground for disordered eating. Models get into the business when they are young and impressionable. They are often completely isolated from their support systems and they're thrown into a highly competitive environment where their success depends largely on their bodies. Take those factors off the runway and put them on a track or an ice rink or in a swimming pool and the risk for eating disorders is still sky high.

Many have questioned whether the fashion industry is doing enough to protect the health of models, but there has certainly been plenty of discussion and enough movement to develop some basic guidelines. The International Olympic Committee issued its own guidelines in 2005--in the form a 46-page position on the Female Athlete Triad (Disordered Eating, Osteoporosis, and Amenorrhea). While comprehensive, this paper is far from user friendly. The IOC also states that "International and National Federations and National Olympic Committees are encouraged to develop coach and team physician Female Athlete Triad education programmes, and where possible modify rules to reduce the incidence of the drive for thinness and subsequent unhealthy eating behaviours." Is that happening? If you know about any such programs or rule modifications, please let us know. Our search came up with nada.

Miley Cyrus: Good for Girls' Body Image

Despite the whole "stripped down naked in a blanket" Vanity Fair incident, Miley Cyrus and her after-school tween TV peers appear to be setting a positive example for girls--at least when it comes to body image. According to a new study, children's shows like Hannah Montana and That's So Raven do a better job at showing a range of body types than shows for adults do.

The study found that almost half (47 percent) of the major and minor characters on these shows were of average weight, 38 percent were below average, and 15 percent above. And while this isn't a completely accurate reflection of reality, we are talking about TV here--and it's whole lot more body diversity than what we see in prime time.

The bad news is that while kids' shows are doing a better job at getting away from the stick-thin ideal, there are still plenty of tired old stereotypes about weight. The study showed that 25% of overweight characters on these shows had no friends, and black characters were three times more likely than white characters to be depicted as overweight. [Canada.com]

CFDA Health Initiative Discussion: "We've Been Drinking the Kool-Aid"

I attended a CFDA Health Initiative discussion last night focusing on "The Beauty of Health: How the Fashion Industry Can Make a Difference." [Usually this is a team effort, but Magali is on vacation with her family. She was sorry to miss it.] This was the third health initiative event they've hosted since releasing their guidelines in 2007.

Some highlights:

Nian Fish of KCD (whose Q & A was our very first blog post almost a year ago) is sick of the ultra-thin look. "Size zero. What is that?" she asked the audience, which included Anna Wintour and Donna Karan. "A size zero means you're invisible. I think we have brainwashed ourselves into believing that is beautiful. It's time to admit that we've all been drinking the Kool-Aid."

James Scully has been an outspoken advocate for reform in fashion, so I was happy to see him step up to the microphone. As one of the most sought-after casting agents in the industry, he knows that he and his colleagues have a responsibility to understand the power of their words and the tremendous influence they can have in young models' lives. "Magali talks about how her life would have taken a different turn if she had received caring support instead of harsh words about her weight," he said. "I think about that every day. Let's stop treating models like greyhounds we plan to shoot after a race. We have to remember we are dealing with real people who have real feelings."

Michael Kors also reminded everyone to treat models as humans, not mannequins. He challenged designers to "stay away from child-size clothes unless you're designing for children,"
pointing out that fashion influences the Hollywood aesthetic--and when celebrities starve themselves to fit into sample sizes, it has a dangerous and far-reaching influence on girls and women everywhere.

Model Coco Rocha did not hold back. She said that a day in the life of most models involves an obsession with staying thin, a constant hunger, and cutting remarks like "We don't want you to be anorexic. We just want you to look like you are." She admitted that an agent once advised her to throw up after meals. Last year she gave in to the pressure and took diuretics--a decision she seriously regrets. After consulting other models, she offered four recommendations:
1. To designers: make your fit models bigger (i.e. make your clothes bigger). When zippers don't zip up at castings, models suffer unbearable humiliation.
2. Keep working to raise awareness about the long-term effects of eating disordered behavior. If young models knew the permanent damage they were causing to their bodies, they might think twice.
3. Agencies need to be closely linked with medical professionals, including nutritionists and eating disorder specialists.
4. Provide healthier food at shows.

I left the discussion with a hopeful outlook. Go ahead, call me the eternal optimist. Magali and I have been working to raise awareness about eating disorders and body image issues in the fashion industry since 1999. For many, it might seem as though change is happening at a snail's pace. But in the span of our work together, the last two years have felt like giant leaps forward. More and more people are finally speaking the truth. We need that kind of honesty. We can't get to a healthier place without it.

Bigger, Stronger, Faster: The Side Effects of Being an American

Meet Christopher Bell. That's him in the before and after photos. In one of the most compelling scenes of his movie, Bigger, Stronger, Faster, Bell shows the audience just how easy it is to manufacture and market a dietary supplement in the United States. He orders the ingredients, mixes them up in his kitchen, pours them into capsules, and works with a photographer to create an ad.

"Look as sad and depressed as you can," says the photographer as he snaps the first photo. Then Bell gets waxed and Photoshopped. Suddenly, he's "shredded." No need for FDA approval. No restrictions on his completely manipulated advertisement. It's all 100% legal.

While Bigger, Stronger, Faster focuses primarily on steroid use in America, it is ultimately an exploration of our culture's confusing messages about being the best. Our bodies and our spending habits are certainly evidence of our desperation to be extraordinary. Women are on a quest for thinness and eternal youth. Men feel more and more pressure to have rock hard muscles and six-pack abs. Some of Bell's subjects are extreme examples (Gregg Valentino's enormous biceps are disturbing, to put it mildly), but this is no freak show. It's a film about how our supermodel, supercelebrity, and superathlete worship is making it increasingly difficult to accept--and be happy--with ourselves.

Bigger, Stronger, Faster is open in these theaters.

The Cookie Diet? Really?

Cookies are getting some serious hype in Los Angeles these days. One of my modeling agents mentioned to me that another model recently dared to walk into the agency's office with a cookie in her hand. So of course, as any conscientious agent would do, she proceeded to grill said model. Was she out of her mind to be eating a cookie in her state (apparently this slender, young thing "needed" to be on a diet)? Well, as if all was natural and good in the world, that model informed my agent that it was A-okay because this wasn't just any cookie--this was the cookie diet.

The model munched on the cookie and proclaimed that she could eat these all day, have a strict dinner, and the pounds would melt off. "Had I heard anything about this?" asked my bewildered agent. I could not believe the irony of a situation in which my modeling agent was actually asking for my thoughts on a fad diet. I pinched myself, then I called Claire to vent and do some research.

It wasn't hard to find information about the cookie diet. There are many versions, but the original was developed by Dr. Sanford Siegal in the 1970s. The kind doctor pretty much admits that his cookies taste like ass ("They taste good but we wouldn't call them delicious. Delicious cookies make people fat," he says on his website), but we had to dig a little deeper to find the real secret of how these cookies make people lose weight. Turns out that if you eat the prescribed number of cookies instead of, oh, actual meals, followed by a low-calorie dinner, you'll be consuming about 800 calories a day. That's what I (and any responsible doctor) would call starvation.

The next day I go to check out some houses with my realtor, and what does he ask me? Do I know anything about this amazing diet he just checked out online? It sounds really good. It's called...the cookie diet. At this point, I was half expecting Ashton Kutcher to jump out of the bushes. What is it with these ridiculous fad diets? Most of the time they're old diets repackaged to sound new and exciting. And if any of them actually worked, we would surely know by now.

Why would any person with even a shred of intelligence take this diet (or any other fad diet) seriously? I think the answer lies not just in our desperation to lose weight, but in the belief that we can trust in products that have a doctor's stamp of approval. On some level, we still believe that doctors are here to help people, and whenever a doctor or a person with all the right credentials comes up with a new diet, miracle pill, or exercise plan, too many of us trust that they wouldn't recommend something dangerous or harmful. After all, isn't that their vocation? Isn't there that "First, do no harm" oath they have to take?

Well, I said goodbye to the era of the supermodel a while ago, and I think we're in a new era of medicine, too. It's not one I'm too happy about. There are still plenty of good guys (and gals) out there, but I feel like more doctors are out to make a buck than ever before. We have the insurance companies and our out-of-whack health care system to thank for that. Which is why, when I was waiting in my OBGYN's office last week, I looked around the room and saw pamphlets about Botox, vein removal, hair removal, and all sorts of things that have nothing to do with gynecology. And it scared me.

Australian Newscaster's Suicide Linked to Anorexia

29-year-old Charmaine Dragun, a newscaster for Australia's Channel 10, committed suicide last November. She had a thriving career and marriage plans, but her family and close friends are now revealing that Charmaine struggled with depression and anorexia. She was taking anti-depressants at the time of her death. Her mother recalls that Charmaine became dangerously preoccupied with her weight in college after some construction workers whistled at her.

"She kept walking, of course, but she also heard some comments," Mrs Dragun said. "The comments were 'She's pretty good looking isn't she - except that she's got a fat arse, what a shame'. This seemed to be the trigger."

Comments like those certainly don't cause eating disorders, but they're called triggers for a reason. According to those closest to her, Charmaine was already prone to depression and perfectionism. The ingredients for an eating disorder were there, and hearing that she had a 'fat arse' set the behavior in motion.

That's why we all have to be kind with our words, and make a conscious effort to push back against a culture that has made it so acceptable to scrutinize people's weight. Celebrity tabloids, weight loss and plastic surgery makeover shows, and mean-spirited gossip blogs have trained us to believe that construction worker-style comments about women's bodies are okay. This tragic story should wake everyone up to the fact that they're not. You just never know how deeply those jabs will wound the person on the receiving end. [ABC News]

Three Out of Four American Women Have Disordered Eating

A new survey by Self magazine in partnership with the University of North Carolina shows that sixty-five percent of American women between the ages of 25 and 45 report having disordered eating behaviors and an additional ten percent reported symptoms consistent with full-blown eating disorders like anorexia and bulimia. The disordered eating behavior in this study cut across racial and ethnic lines and was not limited to a particular age group either.

So basically what this means is that the majority of women in this country are experiencing serious distress related to food and weight. This distress is so normalized and validated that most women probably don't even recognize it as disordered. Women turn to makeover books and TV shows instead of support groups. Girlfriends talk to girlfriends about their latest extreme diets, but it doesn't occur to them that they could (and should) talk to therapists about how often they feel genuinely depressed about their weight. When we feel bad about ourselves, we think weight loss is the solution. But more often than not, our weight loss attempts only make us feel worse--physically and emotionally.

• 75 percent of women report disordered eating behaviors or symptoms consistent with eating disorders; so three out of four have an unhealthy relationship with food or their bodies
• 67 percent of women (excluding those with actual eating disorders) are trying to lose weight
• 53 percent of dieters are already at a healthy weight and are still trying to lose weight
• 39 percent of women say concerns about what they eat or weigh interfere with their happiness
• 37 percent regularly skip meals to try to lose weight
• 27 percent would be “extremely upset” if they gained just five pounds
• 26 percent cut out entire food groups
• 16 percent have dieted on 1,000 calories a day or fewer
• 13 percent smoke to lose weight
• 12 percent often eat when they’re not hungry; 49 percent sometimes do

[Science Daily] [Self]

It's Not Just a Girl Thing: John Prescott Talks About His Bulimia

Former U.K. deputy prime minister John Prescott has admitted that he suffered with bulimia for twenty years, a struggle he details in his forthcoming autobiography.

"I've never confessed it before. Out of shame, I suppose, or embarrassment - or just because it's such a strange thing for someone like me to confess to," he said. "People normally associate it with young women - anorexic girls, models trying to keep their weight down, or women in stressful situations, like Princess Diana." The reality is that men in stressful situations resort to disordered eating, too. It's just not talked about as much. The National Eating Disorders Association estimates that 10% of patients treated for eating disorders are men. But there are certainly many more men who aren't reflected in that statistic--men who are ashamed to come forward because of the stigma attached to having a "woman's problem."

We will echo the praise of many other eating disorder experts and advocates who have thanked Prescott for his honesty. Hopefully his admission will open the door for other guys who might be afraid or embarrassed to seek help. [Guardian]

Anna Wintour Says Models Today Are Pale, Thin, and Joyless

Anna Wintour was not impressed with the models at New York Fashion Week. "Overall, they were pale and thin and entirely lacking in the joyfulness and charm that once defined the supermodel," she writes in the April issue of Vogue. "This is, of course, not their fault: Designers now near-uniformly favor a non-vivacious, homogenous ideal." Oh, snap. And therein lies one of the central problem with tackling the fashion industry's too-skinny beauty standards. The good news is that we've gotten to the point where even the most powerful industry leaders recognize that something is awry. The bad news? Everyone thinks someone else is responsible.

Designer Bradley Bayou, whose daughter suffered from an eating disorder, is calling for a cease fire in the industry blame game. "If everybody takes responsibility and everybody works together, we can change it. In other words, the designers and the editors and the modeling agents and the models' parents and everybody gets together and decides, 'This is not a healthy thing. We must change it.' Then, hopefully, we can." We'll second that. [CBS News]

The Inflated, Overblown "Cost of Obesity"

Daniel Engber (associate editor at Slate) wrote an excellent op-ed for Sunday's Dallas Morning News slamming politicians for consistently blaming the "obesity crisis" for the rising costs of health care. In fact, our country's abysmal body image problem is the crisis we should really be talking about.

Research shows that body image has a bigger impact on overall health than weight does. Moreover, the rush to institute childhood obesity prevention programs may actually be turning kids on to disordered eating habits--and eating disorders certainly won't minimize health care costs. "[P]residential candidates should pledge support for a federal ban on weight-based discrimination," writes Engber. "If we stop blaming fat people for our problems, they might start feeling better – and start saving us money." [Dallas Morning News]

Illustration: Dan Page

Do You Blog About Eating Disorders?

Over at The-F-Word, Rachel is conducting an anonymous survey of bloggers who write about their own recovery from eating disorders or their current struggles. She hopes to discuss her findings at The National Eating Disorders Association conference this fall in a presentation that will explore the role that blogging plays in eating disorder recovery. The survey has 40 questions, so set aside some time if you want to participate. Take the survey here.

Medical Students Don't Want to Be Primary Care Doctors. The Money is in Botox and Eye Lifts.

Did you know that there's a shortage of family doctors in America? Today's top-tier medical students are fighting to get into the most competitive residencies: dermatology and plastic surgery. These fields offer the best hours and the biggest paychecks. Not surprisingly, they are attracting the most ambitious and successful students with the highest medical board scores.

“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Massachusetts.

We're not saying that dermatology and plastic surgery aren't legitimate and valuable professions, but will anyone deny that the skyrocketing popularity of these fields is at least in part (and we'll argue that it's a big part) a reflection of how our culture values physical appearance over everything else? Those values are now evident in our health care system, which could certainly do with a makeover anyway. [New York Times]

Jezebel Bans Body Snark. You Can, Too.

It's not easy being a pop culture junkie and an advocate for positive body image. Those two passions don't always play nice. That's why it helps to have some practical ground rules.

Back in January, Jezebel made a resolution to put a stop to negative comments about people's bodies. This was not a ban on celebrity gossip, fashion, or snark in general (because frankly there are some of us who might melt away without them)--just the mean-spirited body bashing that can spring from the intersections. They're sticking to their guns, too. Every day Jezebel editors choose the best and worst out of hundreds of comments submitted on their blog. The offenders are often those who can't stop themselves from making a nasty dig about a celebrity's weight.

This is the kind of stance that can shift people's thinking and change conversations and behaviors for the better. It's really as simple as creating and enforcing community policies that match your values. Wish women would stop talking trash about their own (and each other's) bodies? Well, fellow bloggers and media makers...we can all start in our own backyards. By the way, our blog also has a permanent ban on body snark. But you probably knew that already. [Jezebel]

Girl Scouts Sell Cookies in 100-Calorie Packs With Calorie-Burning Tips for Girls

It's that time. Thin mints, Samoas (er, make that "Caramel deLites"), Peanut Butter Patties. Yum. But this year your friendly Girl Scout troop will have some new offerings, including 100-calorie packs printed with activities that girls can do to burn off the cookie calories. “Girls can burn calories and have fun with 30 minutes of activities like these: Ice Skating—126 calories. Gymnastics—72 calories…” Oh, no they didn't.

I feel for the Girl Scouts. I really do. I'm sure they've come under fire for contributing to the much-discussed childhood obesity epidemic when they're just trying to raise money for their programs by selling some sweet treats. Their ABC Smart Cookies website is clearly an attempt to show that they care about girls' health, which they shouldn't have to prove to anyone considering that the organization has been helping girls since 1912. I'm all for encouraging girls to be active, but providing calorie counting and burning tips is a slippery and dangerous slope. This seems like a glaring example of an attempt at obesity prevention that is just ripe for major backfiring. And research shows that many similar initiatives are resulting in disordered eating and an unhealthy fear of fat in kids.

To be honest, my stomach drops when I imagine girls eating their little packs of Cinna-Spins, then checking the Girl Scouts calorie counter to see how they should burn off the calories. Actually, I think I feel too sick about it to eat any cookies now. [Ken Levine] [Girl Scouts]

Doin' It for the Kids: A Tribute to Moms

Kelly over at Fitness Fixation wrote a very moving piece this week about how her six-year-old daughter is already hearing the "F" word at school. No, not that "F" word. The other one: Fat.

“You know how everyone has that extra skin and stuff at the top of their leg? Two boys pinched me there and said, ‘You’re fat.’ But I’m not, everyone has that,” Kelly's daughter reported back to her one afternoon. While her little girl didn't seem to be devastated by the comments, Kelly was enraged, frustrated, and motivated to cancel her women's magazine subscriptions.

"I get a lumpy throat if I think of a slightly older her, critically examining her legs in the mirror, wondering if they are big or jiggly and maybe she ought to eat a few less cookies and try some stupid cream and will she get dates with legs like that? Did I say lumpy throat? Make that nauseous," she writes.

There's no sugar coating it. Moms who are working every day to instill healthy body image and strong self-esteem in their children are fighting an uphill battle. But you know what? It's a battle well worth fighting. So to Kelly and all the other amazing moms out there: keep up the incredible work. Your daughters and sons will thank you.

Australian Prime Minister Addresses Body Image Issues on International Women's Day

You're probably aware that March is Women's History Month, but did you know that Saturday, March 8th was International Women's Day? There was barely any mainstream media coverage of the day from what I could tell, so I was happy to see this article, which mentions Australian Prime Minister Kevin Rudd's decision to recognize International Women's Day by taking part in the Get Real Forum. The event was organized to raise awareness about body image issues.

"International Women's Day... provides an opportunity to celebrate the achievements and contribution of women in our society," Rudd said. "However, too often the focus on women is about their body and image. Women and girls are often bombarded with unrealistic images of females which can have adverse consequences on their body image, health and wellbeing." [The Age]

More Eating Disorder Sufferers are Children

Children of younger and younger ages are developing eating disorders, and at least one expert is pointing to cultural pressures to be thin.

"We have seen a 300 percent increase in the number of calls from preteen patients," said Amy Gerberry, program director and therapist at Remuda Ranch's children's program. "Eating disorders are increasing rapidly in preteen girls. It's because of our culture's obsession with dieting and thinness."

"Children are being targeted with messages and products promoting diets and body image dissatisfaction," adds Gerberry. "There are more and more sexualized and objectified images of children in the media today than in the past."

Outside of treatment centers, 63% of elementary school teachers now say they are concerned with eating disorders in their classrooms. [Fox News]

C-Section Births are at an All-time High

According to the National Center for Health Statistics, the number of women giving birth via cesarean section has increased 50 percent in the last ten years. C-sections now account for one third of all U.S. births.

No one is exactly sure who or what to blame for this record-breaking increase. Some say it's demand from women who want to schedule their births the Christina Aguilera way. "I didn’t want any surprises," the pop star told People magazine. "Honestly, I didn’t want any [vaginal] tearing...The hardest part was deciding on his birthday. I wanted to leave it up to fate, but at the same time I was ready to be done early!”

While the convenience factor of a scheduled c-section is a draw for many women, experts are concerned that too many of these procedures are elective and not medically necessary. C-sections are not without risk. Researchers found that neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62).

Perhaps our largest concern is whether mommies-to-be are getting enough information about the birthing options available to them. Pregnancy can be a confusing, exhilarating, head-spinning time. Women need to fully understand their choices in order to make the decision that's right for them.